A couple of weeks ago I read an article over at Mill Hill Ave Command about the new Anaphylaxis protocol they are using in Connecticut. Here is a link to the article. Those of you who have followed my ramblings for a while know that I’m kind of a skeptic when it comes to Anaphylaxis. While we see a fair number of relatively minor allergic reactions, true, life threatening anaphylaxis has been pretty rare in my experience. Well, since reading that article, that has changed. Whether that’s because I’ve changed my appreciation of Anaphylaxis, just coincidence, or some other cause, I can’t say. I don’t think it’s more than just the luck of the draw because if you do enough calls, sooner or later you’re going to get a run of something. I had a co worker once who responded to four cardiac arrest calls in one day. Four, in one eight hour shift. For an EMT in my system at the time, that was a month’s worth. No one has done that many since to my knowledge. I’ve responded to three in a sixteen hour shift, but that was in an ALS unit. Luck of the draw, as I said.
I have a pretty progressive partner, and our protocols have some flexibility, so a couple of years ago we started modifying our practice a bit. EMTs in our system can give Epinephrine for Anaphylaxis only, not for Asthma. To me, it’s kind of a silly distinction, but it is what it is. Even with Anaphylaxis, a lot of EMTs aren’t comfortable sticking a needle into a patient because it’s not something they do very often.
So, what we’ve started doing is using Epi Pens when we give Epinephrine for either Anaphylaxis or Asthma and we have one of the EMTs do the actual injection under our supervision. This is part of what I call our “Immediate Action Drill” for critically ill patients from either Anaphylaxis or Asthma. Either we whip out our Epi Pen and have one of the BLS guys give it or we have them grab it from their kits and give it. One of us supervises the procedure, not because we don’t trust them, but because many of them are very nervous the first time.
The goal is to get them comfortable enough with the procedure that if a paramedic isn’t around and an Anaphylaxis patient need Epinephrine “RIGHT NOW”, they won’t hesitate or decide to wait until ALS arrives. Even though true Anaphylaxis is relatively rare, it’s an immediately life threatening event. Two of the three recent patients were within minutes of dying and while the third had localized symptoms to her airway, the edema was bad enough that we gave an Epi Pen, the hospital gave more and ultimately decided to intubate the patient because the edema just wasn’t going away.
Scary stuff and hopefully our efforts will help both EMTs and patients.